Leslie Schover, PhD, is not the biggest fan of the new National Comprehensive Cancer Network guidelines on cancer survivorship---at least not the section on sexual function. "Great concept, totally
impractical," she said at a session at the American Society of Clinical Oncology's annual meeting in Chicago.
For women, the guideline first recommends an initial interview
assessment. "If you discover any kind of problem, it would take at least five
minutes just to get through that questionnaire," said Dr. Schover, a clinical psychologist and professor at the University of Texas MD Anderson Cancer Center in Houston. The initial assessment for men involves a short self-report questionnaire, but there are problems with that too, she noted, because it only asks about erections and doesn't address other potential issues, such as decreased sexual desire, pain, or changes in orgasm function.
"Then, if you find a problem,
you’re supposed to right then and there do a more complete sexual history, counsel
the person on the impact of their cancer treatment on their sex life and their
fertility, and do a physical exam," Dr. Schover said. "My question is, who’s going to spend 20 to
30 minutes on sexuality with literally half the patients in most oncology
treatment settings?" Not only is there a lack of expertise in this area, she said, insurance coverage can also be problematic.
As an alternative method that would achieve some of the same goals, Dr. Schover recommended following a model more like that used for psychological conditions in the U.K., which involves providing patients access to classes, written workbooks, or websites that can then be supplemented with phone counseling or
e-mail feedback, often by a peer or a trained nonprofessional coach. Individual therapy with a professional can then be offered to patients who need it.
Dr. Schover said her research group, funded by small business
grants from the National Cancer Institute, has developed websites on sexuality and fertility in cancer patients that also incorporate video vignettes and interviews, which she feels could be helpful given the very private nature of the topics. "Many people might not go to a support
group but might be willing to use a website," she said.
